Today, the Substance Abuse and Mental Health Services Administration (SAMHSA) in conjunction with the 18th annual National Inhalants & Poisons Awareness Week released a survey that indicates that more 12 year olds have used potentially deadly inhalants than cigarettes or marijuana, perceiving it to be “Safer”.

The need to increase awareness of this public health risk among physicians, parents and others is critical.
They may sniff refrigerant from air conditioning units, aerosol computer cleaners, glue, air fresheners, hair sprays, nail polish, paint solvents, degreasers, gasoline, or lighter fluids, with the intention of getting high. These substances are readily available, inexpensive, and easily hidden where they were found, in garages and household cabinets.

Most youth believe that huffing is “safer” than using illegal substances, and are unaware of its deadly potential. Most parents are not aware that use of inhalants can cause “Sudden Sniffing Death” – immediate death due to cardiac arrest – or lead to addiction and other health risks.

SAMHSA data from the 2006-2008 National Surveys on Drug Use and Health show a rate of lifetime inhalant use among 12 year olds of 6.9 percent, compared to a rate of 5.1 percent for nonmedical use of prescription type drugs; a rate of 1.4 percent for marijuana; a rate of 0.7 percent for use of hallucinogens; and a 0.1 rate for cocaine use.

“Parents must wake up to the reality that their child might try huffing and the consequences could be devastating,” said SAMHSA Administrator Pamela S. Hyde, J.D. “That’s why SAMHSA is leading the way to get information out to healthcare providers, kids, parents and everyone in the community so that our children hear a consistent message about the dangers of huffing.”

“Young people and their parents are key audiences for this important public information campaign about the clear and present dangers associated with inhalant abuse,” said Gil Kerlikowske, Director of National Drug Control Policy. “With data showing that young people often don’t perceive the great risk of abusing inhalants, we must redouble our efforts to inform adolescents of the dangers and to encourage parents to be more vigilant in protecting their children from inhalants often present in common household products.”

It is possible to die from trying inhalants even once. ‘Sudden Sniffing Death’ causes the heart to beat rapidly, which can result in cardiac arrest.

Researchers under Dr. Matthew State, an associate professor of child psychiatry, psychiatry and genetics at Yale University School of Medicine. have been studying the genome of a family in which the father and all eight of his children have Tourette Syndrome and have identified a mutation on the HDC gene that encodes the enzyme L-histidine decarboxylase, which is involved in regulating levels of the neurotransmitter histamine in the central nervous system.

This research provides clues to treating Tourettes Disorder, a neurological disorder that can cause debilitating, involuntary motor and verbal tics.

While the variant itself is likely very rare — meaning most people with Tourette syndrome don’t have the precise mutation — what’s known about the gene’s function in the body hints at new treatments, researchers explained.

Previous research in mice has shown that manipulating brain levels of histamine by decreasing activity of HDC makes mice more likely to have repetitive behaviors, such as biting, rearing and chewing, which may be similar to tics in humans.

Drugs that increase the release of histamine in the brain, but don’t affect histamine levels in other parts of the body, are in the latter stages of development. Previous research has shown that when given to mice, these drugs decrease the repetitive behaviors. It’s possible those drugs could also help people with Tourette syndrome.

Genetics may point to the function of the gene, which points to what kind of mechanisms might be involved in the disorder.

The study is published in the New England Journal of Medicine.

Tourette syndrome tends to run in families. The disorder usually emerges in childhood and, for some, improves in adulthood. Although the causes of the syndrome are unknown, previous research suggests abnormalities in certain brain regions and in the neurotransmitters dopamine, serotonin and norepinephrine may play a role.

Children who see doctors for Tourette syndrome often have other disorders as well, including depression, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or learning disabilities.

Many cases of Tourette syndrome are mild and improve over time. But severe cases can be debilitating — socially and physically — and current treatment options are limited.

In addition to behavioral intervention, first-line medications include antidepressants and anti-anxiety medication. More severe symptoms of the syndrome can be treated with antipsychotic medications such as risperidone (Risperdal) or neuroleptic medications, such as haloperidol (Haldol), but long-term side effects can be serious.

The mutation identified in this family may be unique to them, but suggests the likelihood that functional differences in the HDC gene or in the histamine biochemical pathway would play a role in other families affected by Tourettes.

There were 197 Army suicides in 2008, according to the Army’s numbers. The total includes active- and non-active-duty soldiers.

Last year, the number was 245.

This year, through May, it’s already 163.

The Army has instituted many programs to counsel and train soldiers with a goal of suicide prevention. Several of them have failed. Often, as soldiers transitioned from one assignment to another, the new station was unaware of past mental health issues.

Source: U.S. military branches (2001-09) and Centers for Disease Control and Prevention (latest figures through 2006)

For reports in the United States, we also recommend that you contact the National Suicide Prevention Lifeline, a 24/7 hotline, at 1.800.273.TALK (8255). If possible, please encourage the user who posted the content to contact the Lifeline as well. You can view a list of suicide prevention hotlines in other countries by visiting http://www.befrienders.org and choosing from the dropdown menu at the top of the page.

We encourage you to learn about how to identify and respond to warning signs of suicidal behavior online at the following address: http://www.suicidepreventionlifeline.org/GetHelp/WhatifSomeoneIKnowNeedsHelp.aspx

National Suicide Prevention Lifeline:

Lifeline wants people to report to Facebook first, as Facebook has the ability to provide identifying information and the process is faster if they can report all info to the Lifeline at that time.

Facebook works with the Lifeline once the content is reported.

(If it is international, then Facebook works with the appropriate international organization.)

Facebook receives the notification, then provides the Lifeline with all information about the user. Unfortunately, Lifeline cannot comment on the process from Facebook’s end but believes that given Facebook’s sensitivity to suicide risk and knowing that their safety team works on the weekends, the Lifeline believes that the process is pretty quick and that it is the most efficient and quickest method for a user to receive help.

According to research published in the February Journal of Strength and Conditioning Research, Swinging a weighted bat before hitting doesn’t enable a baseball hitter to swing any faster.

Scientists at three universities asked 22 collegiate baseball players to take three swings each with a test bat, followed by two easy swings with each player’s game bat, unweighted. Each player then hit three balls off a tee. The tests bats included six bats variously weighted, two normal bats without weights and two underweight bats.

A recent story in the Washington Post about the infamous psychiatrist Daniel Amen reminded me why psychiatrists are poorly respected and have such a bad reputation. I am too young to remember lobotomies, or treatments for “hysteria”, but I have read about them. I also had a distant cousin who spent many years in an asylum for “retardation” when, it turned out, she was merely deaf. In recent years, as even the Post article pointed out, we have learned that a many studies of antidepressants were unpublished–specifically those that showed little benefit to of their use.

Despite knowing psychiatry’s sordid history, I have been offended at the many different ways my work has been scrutinized. I resent the insurance companies force me to seek permission to prescribe certain medications from pencil pushers without any medical degree who ask me “And, will the patient be medically monitored while taking this medicaiton?” [Isn’t that a part of the practice of medicine?]

The profiteering and opportunism I believe Dr. Amen has engaged in are specific examples of why our field is so heavily distrusted –and why psychiatrists face so many barriers when trying to practice medicine with honesty and integrity.

I recall a number of years ago when a family of above average (but still middle class) means came to me for the first time. They presented to me a piece of paper from one of Dr. Amen’s clinics, where this child was diagnosed with “ADHD”. That’s fine. I do believe that ADHD exists. And that it usually responds well and robustly to appropriate treatment. HOWEVER, this paper also indicated that this child had a “variant” of ADHD that should NEVER be treated with stimulants, and advised that he be treated only with an SSRI (Selective Serotonin Reuptake Inhibitors are often used to treat depression and anxiety.) This was shocking and preposterous! Nowhere in any literature search in any peer reviewed journal could I find ANY information to support this claim. I worked hard to talk with the family about what exists in the literature about treatment of ADHD, how to treat it, and with what, and about how ADHD is diagnosed. I found myself in the uncomfortable situation of having to prescribe what Dr. Amen advised, or to be cast off as the child’s clinician.

Since then I have seen a handful of other youth with similar reports, whose parents have presented with similar instructions as to how their children should be treated for ADHD. These SPECT SCAN reports have cost families upwards of $3500 apiece, and have no scientific basis except the collections of scans that Dr. Amen himself has, but that have not been introduced to the scientific community for review or assessment. At that price, I could complete a tremendous number of very short medication trials of virtually every agent utilized to treat ADHD, and determine the best agent before even reaching that dollar value.

The Post Article indicates that Dr. Amen has an excellent bed side manner and presence. And that is important. It improves the likelihood that patients and their families will adhere to treatment recommendations, and it increases the likelihood, therefore of a success. But that same great presence and bed side manner can also be used to unduly influence patients and families to embark upon inappropriate treatments–and there are many examples of this: chelation therapy that is actually dangerous and without any positive evidence base, secretin therapy which was expensive and proven to be ineffective, homeopathic treatments which have repeatedly been debunked, and–once again going back to what should be the “dark ages” of psychiatry, “ice baths” to treat psychosis.

Even without intending to, we can become so convinced that something is effective for patients that we lose sight of what scientific evidence tells us. This is why it is important for physicians to continue to attend conferences, to consult with colleagues, and to submit their “data” to the scrutiny of the scientific community. Many people do not know this, but the psychiatrist, Walter Freeman, who performed many of the early lobotomies in the United States was so convinced of the effectiveness of his intervention, that he worked very hard to provide the procedure at minimal cost–simplifying it to an office procedure so that patients who would not otherwise be able to afford it could benefit. In contrast to what appears to be the case with Dr. Amen, who will serve only those capable of paying his exorbitant fees, Dr. Freeman was working hard to be mindful of the needs of even the most displaced and poor patients!

It is shocking to me, that in this era of increased awareness of the undue influence of drug company lunches and dinners on physician prescribing, that Dr. Amen’s multimillion dollar business has not been examined at all by any regulatory authorities. Certainly, even a well-meaning physician can become convinced that something so financially successful–due to patient/family “satisfaction” that his treatments are effective–even when they are not.

Unlike many physicians who are presented with documentation from Dr. Amen’s clinic, I have a fairly significant amount of experience with SPECT scans. They were used at a VA Hospital where I was a student, in an effort to research the progression of Hutington’s Disease in the brains of affected persons. SPECT scanning is complicated, and the subjects must be prepped in a dark room, lying still, and devoid of stimulus, because otherwise, the results are terribly inaccurate. During a SPECT scan, a patient is given an IV that contains certain binding agents that enter the brain and bind areas of high activity. The problem is, that if anything happens while a person is lying in the dark, waiting for the agents to bind, the study can be very misrepresentative about what is going on. Thus, it is impossible for me to fathom that SPECT scans have any capacity to be specific enough to provide useful information about SUBTYPES of ADHD. As the Post article pointed out, SPECT’s limitations have resulted in a number of other types of imaging studies being used more often–particularly PET Scans as they have become more readily accessible and as the technology has become more affordable.

Overall, I think the most important take home messages here are, that:

Patients and parents of patients who struggle with dysfunction from emotional and behavioral disturbances can often be very very desperate. We often have few answers. We often can ameliorate but not cure symptoms. It is important that we be mindful of the vulnerability of the families that we work with.

It is important to help maintain hope, but not to promise miracles.

It is important to remain aware of current evidence-based practices. Physicians must maintain an awareness of the current scientific evidence, must consult with colleagues, and must submit their “data” to the scrutiny of the scientific community–which the Post article points out that Dr. Amen has not done.

It is important for practicing psychiatrists to be have a current understanding of neurobiology and to relate this to clinical presentations and behaviors–so that people like Dr. Amen cannot go on saying that the rest of us do NOT understand the brain.

It is our obligation to help families have as much data as they can to be able to make informed decisions.

It is also our obligation to help them know when, perhaps, their vulnerability is being taken advantage of.

It is REASONABLE to discuss with families interventions that have less evidence, or that are fringe or alternative. When doing so, we MUST help them weigh the risks and benefits, and help them consider a cost-benefit analysis: Is the cost of the treatment that is unlikely to produce harm with the dollars of investment? Or is the family better off to utilize those funds in other ways?

Drugs to treat attention deficit hyperactivity disorder, (stimulants such as Ritalin/methylphenidate or Adderall/ amphetamine) for ADHD, don’t appear to put kids at higher risk of heart problems or death.

Scattered reports of sudden deaths among children on the medications have caused concern among parents and doctors in recent years, and several of the drugs now carry warnings about heart complications and behavioral side effects.

New research findings are reassuring.Funded by Shire, the researchers examined claims data from Medicaid and a commercial insurer. The study includes more than 240,000 kids ages three to 17, who received ADHD drugs and were followed for 135 days on average.

The researchers then compared those children to more than 965,000, who didn’t take the drugs but were of similar age and gender and came from the same states as the users.

That weasy officially for the researchers, because often the claims data didn’t match the hospital records.

Based on the data they could calculate, investigators estimated that there would be six sudden deaths or cardiac arrests per 1,000,000 kids taking ADHD drugs for a year.

That’s slightly more than the four per 1,000,000 kids in the comparison group. But because the numbers are so small, the difference could easily have been due to chance.

There were no strokes or heart attacks in the ADHD group, and the researchers estimate it’s very unlikely that the true rates would exceed 24 cases per 1,000,000 per year.

Rates of death “from any cause,” which were the most reliable numbers in the insurance data, were 179 per 1,000,000 kids per year in the ADHD group and 300 per 1,000,000 in the comparison group.

“For kids who would benefit from ADHD medications, the potential cardiovascular risks should not dissuade physicians from prescribing the drugs,” Hennessy told Reuters Health.

The findings, published in the journal Pediatrics, are in line with two previous reports that didn’t find evidence of a link between sudden death and ADHD drugs.

However, they run counter to one small 2009 study that found stimulant use was more common (1.8 percent) in children who died suddenly from cardiac arrest than in those who died in car accidents (0.4 percent).

One expert who was not involved in the current study said the results were hard to interpret due to the small number of deaths and heart problems.

“The new findings confirm that if there is an association between stimulants and cardiac events, it is quite rare,” Almut Winterstein, of the University of Florida College of Pharmacy in Gainesville, told Reuters Health.

But she added that at this point, there is no telling how the millions of kids on ADHD medicines will fare down the road.

“We will need to wait another decade to understand whether even slightly increased blood pressure and heart rate over several years during childhood results in increased cardiovascular risk in later life,” she said in an email.

The risk of death is certainly no higher in children who take ADHD medications than in children who don’t,” said Sean Hennessy, a pharmacist at Philadelphia’s University of Pennsylvania, who led the work.

Hennessy acknowledged that studying cardiovascular events using insurance data in youth is complex, and that he awaits the results of The U.S. Food and Drug Administration’s large safety study on stimulants.

The Controversy

The media has continued to highlight the high-stakes battle that pharmaceutical companies have waged to make a profit by convincing doctors to prescribe antidepressants. Recent articles have focused more on the fact that pharmaceutical companies were not made to release studies that failed to demonstrate effectiveness of their products. Some articles have focused more on the failure of manufacturers to reveal potential adverse reactions or side effects.

This unbalanced media coverage has the potential to undermine effective treatment of psychiatric disorders. While the pharmaceutical companies stand to profit by convincing people that mental health conditions are medical conditions, the potential to profit does not necessarily mean that their facts are wrong.

Depression as medical illness

Depression is a medical condition. Studies of the brains and the biology of persons with depression have proven that there are real functional and physical changes that take place when a person is struggling with depression. Depression, and 7 other mental health conditions, are identified by the World Health Organization as among the top 10 most disabling medical conditions worldwide.

Depression can be treated effectively. Studies have consistently shown that medications can treat depression. It is not a one-drug-suits-all approach. Treatment requires some trial and error. But the same is true for the treatment of hypertension. In addition, much like changes in one’s life circumstances can alter a person’s severity of hypertension, so, too can a change in one’s life circumstances make depression better–or worse! Some psychotherapeutic interventions, such as cognitive behavioral therapy or mindfulness based cognitive therapy have been shown to improve depression as well.

The controversy that exists about antidepressant medications is not about whether they are effective, but instead about whether the drive for profit has resulted in overarching assertions that these medications are THE ANSWER for EVERYONE. While the controversy continues, people continue to experience depression at alarming rates, and many people seek help to minimize the impairment that their depression produces. It remains very difficult to analyze the data to determine whether antidepressants will for an individual patient.

So, what is the depressed person to do?

Find a provider that is willing to listen, to ask for details, and to take the time necessary to assess whether an individual patient is responding to the treatment efforts.

Find a provider who is willing to provide education and answers about their treatment decisions, and to include the patient’s preferences in their decision making.

Find a provider who can be flexible and adaptive in their approach, willing to try something different if a patient is not responding, and who is willing to obtain consultations from other experts when necessary.

Free time is not always a fun time for people with autism. Giving them the power to choose their own leisure activities during free time, however, can boost their enjoyment, as well as improve communication and social skills, according to an international team of researchers.

“For many of us, we look at recreation as a time to spend on activities that are fun and that are designed for our enjoyment,” said John Dattilo, professor of recreation, park and tourism management, Penn State. “But for some people with disabilities, particularly those who have autism, these activities can be a source of frustration, simply because they didn’t have a chance to make their own leisure choices.”

Dattilo said that a group of 20 autistic adults who participated in a yearlong recreation program that offered them a chance to choose activities, scored higher on personality tests that measure social and communication skills than the control group of 20 autistic adults who were randomly assigned to the program’s waiting list. Participants met for two hours each weekday and could choose among several activities that promoted engagement and interactivity, including games, exercises, crafts and events.

The researchers, who released their findings in the current issue of Research in Autism Spectrum Disorders, said that after completing the program, participants showed significant improvement at recognizing and labeling emotions. The participants scored about 24 percent higher than the control group in the ability to recognize emotions in a person in a picture. The score of the participants’ ability to label those emotions correctly was 50 percent higher than the control group’s score.

Since people with autism are less willing to interact socially, caregivers are particularly interested in programs that help improve social and communication skills, according to Dattilo, who worked with Domingo Garcia-Villamisar, professor of psychopathology, Complutense University of Madrid, Spain.

“The big measure for us in this program was the improvements in social behavior and interaction,” said Dattilo. “The defining quality of people with autism is that they have difficulty in social situations.”

The participants also improved their ability to carry out executive functions, such as setting goals and maintaining attention.

Dattilo said recreation programs that encourage people with autism to make their own leisure choices create a cycle of increasing independence, rather than a pattern of reliance on caregivers to provide recreational activities.

“While people are learning, you can also give them choices,” said Dattilo. “And as they make those choices, they are also learning and are empowered to make even more choices.”

The works of University of Rochester psychologist Edward Deci and author and psychologist Mihaly Csikszentmihalyi inspired the researchers to pursue the experiment, Dattilo said. Deci and Csikszentmihalyi emphasize self-determination as a critical component of human fulfillment.

In 2005, the FDA issued a black box warning for antidepressants and suicidal thoughts and behavior in children and young adults.

Many clinicians felt that this warning was inconsistent with their clinical experiences, and that it was not consistent with the data.

In Wisconsin, the rate of prescribing these agents to children did not decrease after the black box warning was issued, and the rate of suicide did not change. In other states, where the rate of prescribing of antidepressants decreased, there was an observed increase in suicidality.

Researchers have now completed a study intended to determine the short-term safety of antidepressants by standard assessments of suicidal thoughts and behavior in youth, adult, and geriatric populations and the mediating effect of changes in depressive symptoms. They used data from intent-to-treat person-level longitudinal data of major depressive disorder from 12 adult, 4 geriatric, and 4 youth randomized controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride.

They extracted data from the suicide items of the Children’s Depression Rating Scale–Revised (CDRS-R) and the Hamilton Depression Rating Scale as well as adverse event reports of suicide attempts and suicide during active treatment. Data were analyzed from 9185 patients (fluoxetine: 2635 adults, 960 geriatric patients, 708 youths; venlafaxine: 2421 adults with immediate-release venlafaxine and 2461 adults with extended-release venlafaxine).

An analysis of the data showed that suicidal thoughts and behavior decreased over time for adult and geriatric patients randomized to fluoxetine or venlafaxine compared with placebo. No differences in suicidality were found for youths on fluoxetine or effexor compared to placebo. In adults, reduction in suicide ideation and attempts occurred through a reduction in depressive symptoms. In all age groups, severity of depression improved with medication and was significantly related to suicide ideation or behavior.